1. Oral Health Training Among Graduating Pediatric Residents Gretchen Caspary, PhD David M. Krol, MD, MPH Suzanne Boulter, MD Martha Ann Keels, DDS, PhD Giusy Romano-Clarke, MD

2. Background Early Childhood Caries (ECC) is the most common chronic disease in American children –20% of infants and toddlers low income families –40% of Asian and Native American children –As many as 6.4% of the total population of 1 yr old children –Disease prevalence increasing ECC Risk factors –Frequent and prolonged tooth exposure to sugars –Mutans Streptococcus (MS) –Oral health history of mother and older siblings

3. Background: Pediatricians’ role Novel approach integrates oral health promotion activities in infants and young children pediatric care until they secure a permanent dental home

4. Background: Pediatrician’s Role Assessment of early tooth decay risk, oral screening, anticipatory guidance regarding etiology of caries and disease prevention strategies, ± fluoride varnish, referral to dental provider

5. Background: Pediatrician’s Role Risk Assessment

6. Background: Pediatrician’s Role Proper nutrition

7. Background: Pediatrician’s Role Oral Hygiene

8. Background: Pediatrician’s Role Oral Health Initiative: Partnership to Reduce Oral Health Disparities Third Edition of Bright Futures

9. Background: Pediatrician’s Role

10. Objectives of the Study To Assess Pediatric Residents: Beliefs regarding role of pediatrician in oral health promotion Amount of oral health instruction received Ability to determine oral disease risk and perform an oral screening Comfort in providing oral health anticipatory guidance

11. Study Design AAP’s annual Survey of Graduating Pediatric Residents (2006) Random selection of residents from programs nationally Set of core questions and annual focus subject 1,000 surveys sent Response rate: 61.1% (n=611) Surveys sent both by US mail and via email link

12. Demographics 74% females 63% white non-Hispanic 5% African American 21 % Asian or Pacific Islander 22% international medical graduates 68% married or living with a partner 1/3 with children

13. Oral Disease Prevalence Encountered in Patients 48% pediatric residents reported moderate to severe dental problems in 25%-50% of their patients 16 % reported moderate to severe dental problems in 51%-99% of their patients

14. Residents support the idea of pediatricians performing oral health assessment tasks Survey question: “Do you believe pediatricians should perform the following?”

15. Attributes of residents supporting pediatricians’ involvement in oral health promotion Dependent variable: Score on a scale indicating attitudes on whether pediatricians should conduct oral health screenings 0 = should not, 6 = should

16. Residents’ Oral Health Training 35% reported no oral health training 73% had less than three hours oral health education activities Only 14% had clinical observation time with a dentist Only 21% felt their residency was very good or excellent in preparing them to do an oral health assessment

17. Satisfaction with oral health risk assessment preparation Survey question: “Overall, how would you rate your residency in preparing you for each of the following activities?”

18. Self-confidence in performing oral health assessment tasks Survey question: “For the following oral health assessments/tasks, how would you rate your ability to perform?”

19. Impact of Oral Health Training on Self-Confidence

20. Conclusions Most graduating pediatric residents support a pediatrician’s participation in oral health promotion activities Majority of current pediatric residency curricula lack adequate oral health training As little as 3 or more hours of oral health training can improve pediatricians’ confidence in performing oral health promotion tasks

21. Future Directions Introduce oral health training in all pediatric residency curricula Increase opportunities for interdisciplinary interactions between dental and medical providers in training Address the barriers to pediatricians’ involvement in oral health promotion (time, reimbursement, dental referral network)

22. In This I believe If our American way of life fails the child, it fails us all Pearl S. Buck